Primary Care Coding Alert

Question: What procedure codes should we submit for a gynecology exam and Pap smear?

Montana Subscriber

Answer: From a CPT perspective, you do not have a code choice specific to a gynecology exam and collection of a Pap smear specimen. If the exam and specimen collection are problemoriented (i.e., the patient has presented with a chief complaint leading to the exam), then the exam and specimen collection are simply part of the E/M service otherwise reported for the encounter (i.e., 99201-99215, Office or outpatient visit . . .).

More typically, a gynecology exam and Pap smear collection are considered a "well-woman exam." In this situation, they should be considered part of and reported with the appropriate preventive medicine visit service (such as 99395, Periodic comprehensive preventive medicine reevaluation and management of an individual . . . ; 18-39 years), since preventive medicine visits include an age and gender appropriate history and exam.

Some payers may allow separate reporting of the Pap smear specimen collection using CPT code 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory). Since this is not universally true, you may want to check with your respective payers before doing so.

Screening change: Finally, note that Medicare does have separate codes for these services when provided on a screening or preventive basis. Specifically, you may report G0101 (Cervical or vaginal cancer screening: pelvic and clinical breast examination) for the pelvic/breast exam, if your physician documents at least seven elements of the female exam, as noted in section 40 of chapter 18 of the Medicare Claims Processing Manual. You may report Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) for obtaining the Pap specimen. Medicare pays for these two codes every year for women at high risk for cervical cancer (you can find their high risk criteria on the CMS web site under the Preventive Services section), and every two years for low risk women, for whom you'd need an Advanced Beneficiary Notice if provided more frequently.